Trigeminal neuralgia is characterized by unilateral paroxysmal facial pain. Patients often describe this pain as "the most sever pain one can suffer". Vascular compression of trigeminal nerve root directly near brainstem by artery or vein is considered the main etiology of trigeminal neuralgia. Consequently, basic pathogenetic treatment is vascular decompression of trigeminal nerve root that allows to eliminate the cause of pain. 140 patients with trigeminal neuralgia were operated in Burdenko Neurosurgical Institute since 1998 to 2007. Pain relief after surgery was observed in 96% of cases. There was no mortality in our series, overall delayed complication rate was less than 1,5%. The article deals with clinical presentation of classic trigeminal neuralgia, evaluation of the role of MRI in diagnosis of this disease and description of surgical types of arterial and venous root compression. Authors demonstrated that high effectiveness of vascular decompression depends on correct clinical diagnosis.